A panel at the Eighteenth International AIDS Conference in
Vienna this week recognised the dire level of health need among prisoners and the slow
progress currently being made towards prison health reform. Most countries have
implemented few or no harm-reduction programmes for those behind bars,
providing next to no protection for those involved in risky behaviours such as
needle-sharing and unprotected sex.

Speaking of his own experience, Albert Zaripov of Russia
said that he regularly saw syringes used by 20 or 30 people, with
substances being easily procured. “There was no aid at all, no social aid, no
medical aid, nothing at all,” he said. “This is quite common in places
of … detention.”

Beyond facilitating transmission of illnesses, poor
treatment of infected prisoners sometimes amounts to human rights abuse.
Zaripov recounts that HIV-positive prisoners were isolated and that “people
were afraid to supply them with food and water”. Zaripov describes their living
situation as essentially large 'doghouses', where they were intermittently
brought supplies. “It was terrible, it was just like feeding animals,” he said.

Rick Lines, Executive Director of the International Harm
Reduction Association, reiterated these concerns. “Issues around … poor prison
conditions … affect people living with HIV that much more severely,” he said.
While Zaripov notes that conditions have improved since his release, “In
reality, not many people are receiving ART nowadays. Many people will die
without having seen any therapy.”

Of notable exception to the norm is the Spanish Prison Administration, which has implemented harm reduction and large HIV and HCV
testing and treatment programmes. Of central importance to the Administration’s
work is the early detection of cases in order to allocate appropriate
treatment, coupled with prevention of new cases. As a result of a needle
exchange programme, 200 HIV infections have been avoided annually since
2002.

But panelists warn that Spain is an exception, with most
governments being reticent
– at best
– to improve health indicators. “There are
vast numbers of countries who haven’t done anything at all, and for whatever
reason don’t see the urgency,” said Lines. While Spain is the best model of
practice, the country “is very, very much in the minority”.

Key to this reluctance is the stigma associated with risky
behaviours, such as sex between men and illicit drug use. According
to Kristian Crole of the UN Office on Drugs and Crime's HIV/AIDS unit,
politicians practice “denial to admit that you have … sex between men [and drugs]
in prisons….How can I tell the public if I’m a politician that I let drugs get
in? How can I admit to the public that I’m not doing a good job?”.

Anya Sarang of Russia’s Andrey Rylkov Foundation for Health
and Social Justice continued. “The main barrier is political will,” she said.
“Until the political resistance [subsides], it will not be possible to do
anything.”

Mercedes Galizo Llamas, the Secretary General of the Spanish
Prison Administration, noted that evidence-based policy was able to abate fears
from the general public about harm reduction and other programmes, nothing that
“[Spanish] politicians demonstrate a trust in the public health sector within
the prison system.”

Beyond simply introducing better health care within prisons,
advocates claim that widespread penal reform is essential to truly combat
burgeoning epidemics. “The prison is only one aspect of the criminal justice
system,” said Lines, affirming Sarang’s position that better education was
needed for judges and lawyers. Crole noted that many people currently in prison
“have never seen a judge. In some African countries, they are sitting there for
six, seven, eight years without trial.”

Panel members contend that decriminalisation of drug use is
also necessary. “The root of this public health and human rights crisis … is over
criminalisation of issues dealing with drugs,” said Sarang. In Russia, “almost
every drug case ends with imprisonment.”

Lines observes that most prison health reform that has
occurred resulted from outside advocacy. Prisons have long been seen as
“vectors of diseases”, with prisoners transmitting HIV and other infections
acquired while in detention to the community at large after their release.
“Much progress on prison reforms … has been using public health and fear of
infection and fear of epidemics. People are more likely to care about the
health of prisoners when they get out of prison,” he said. “Public health
continues to offer one of the mechanisms to push for prison reforms, and health-related policies in general.”

Crole suggests that greater visibility of prisoners
and ex-prisoners could be central to pushing for reform. He also suggests that
prison staff could become key advocates, given that they are at risk of being
infected as well as being witness to the neglect of prisoners’ health and human
rights abuses.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.